Family Bonds May Shield Stroke Caregivers From Crushing Burden, Survey Finds

When a family member survives a first ischaemic stroke, the medical emergency ends but a second, quieter crisis often begins at home. A new cross-sectional survey of 915 family caregivers in China suggests that the weight of caring for these patients is not distributed randomly: it rises and falls in step with the caregiver’s own confidence, the emotional closeness of the family, and how well the family functions as a unit. The study, conducted across four tertiary hospitals in Xianyang, Shaanxi Province, offers one of the most detailed portraits to date of the psychological architecture underlying caregiver burden in the immediate aftermath of a first stroke, and it points to family-level interventions as a promising lever for reducing it.

The research team, led by Yang Guo of the Shaanxi Institute of International Trade & Commerce together with colleagues from hospitals in Xianyang and Shenzhen, distributed questionnaires to family caregivers of first-ever ischaemic stroke patients between May 2024 and October 2024. Using convenience sampling and securing informed consent from all participants, the investigators collected 915 valid questionnaires out of 946 distributed, a response yield that lends considerable statistical weight to the findings. The survey was reported in accordance with the STROBE guidelines, the international standard for observational studies, and received ethics approval from the School of Medicine of Shaanxi Institute of International Trade & Commerce under approval number HLX202405032, with all methods conducted in line with the Declaration of Helsinki.

The headline numbers are sobering. The median family caregiver burden score, measured with the widely used Zarit Caregiver Burden Interview, was 40, with an interquartile range of 32 to 53, placing the average caregiver squarely in the moderate burden zone. Self-efficacy, assessed with the General Self-Efficacy Scale, averaged 25.188 plus or minus 5.609, also a moderate figure. Family intimacy, measured at a mean of 51.578 plus or minus 8.796, came out low, while family functioning, with a median score of 7 on a scale where lower reflects better adaptation, was rated as good. In other words, these families were organisationally competent but emotionally distant, a combination the authors suggest may leave caregivers technically supported yet psychologically exposed.

The correlational analysis is where the study’s central claim emerges. Caregiver burden was significantly and negatively correlated with all three psychological and familial variables examined: self-efficacy, with a Spearman coefficient of -0.510; family intimacy, at -0.465; and family functioning, at -0.519. These are moderately strong associations, and they held up in multiple regression models that also accounted for patient characteristics. The factors independently influencing caregiver burden included the caregiver’s self-efficacy, family intimacy and family functioning, along with the patient’s age, level of self-care ability, length of illness, the number of daily caregiving hours, and the caregiver’s own health status. The picture that emerges is of burden as a systems problem rather than an individual failing.

Perhaps the most technically interesting result concerns mediation. Using the percentile bias-corrected Bootstrap method implemented through the PROCESS plug-in for SPSS 27.0, the researchers tested whether family intimacy and family functioning transmit part of the effect between caregiver burden and self-efficacy. Both pathways proved statistically significant. The indirect effect through family intimacy was -0.251, with a Bootstrap standard error of 0.034 and a 95 percent confidence interval of -0.321 to -0.186, accounting for 20.85 percent of the total effect. The indirect effect through family functioning was -0.276, with a standard error of 0.034 and a confidence interval of -0.347 to -0.214, contributing 22.92 percent of the total effect. When the two indirect effects were compared directly, the difference was small and non-significant, at 0.025 with a confidence interval spanning -0.072 to 0.124, indicating that neither pathway dominates the other.

What does this mediation mean in practical terms? The data suggest that a caregiver’s belief in their own capabilities does not operate in a vacuum. Roughly one fifth of the relationship between burden and self-efficacy flows through how emotionally close family members feel to one another, and a similar share flows through how flexibly and cohesively the family adapts to the crisis. A caregiver embedded in a warm, responsive family system appears better positioned to convert confidence into resilience, while a caregiver isolated within a dysfunctional household sees that same confidence eroded under load. This reframes caregiver support as a family-systems intervention rather than a purely individual one.

The clinical implications are concrete. Stroke rehabilitation programmes routinely focus on the patient’s motor recovery, speech therapy and secondary prevention, while the person holding the recovery together at home is often treated as an invisible extension of the hospital bed. The findings argue for screening caregivers of first-ever stroke patients for burden at discharge and during follow-up, and for interventions that target the modifiable psychosocial variables identified here. Self-efficacy can be strengthened through skills training and mastery experiences; family intimacy and functioning can be addressed through family-centred education, counselling and structured communication exercises. Because the two mediators contributed roughly equally, programmes need not choose between emotional and structural approaches.

The study also carries public health weight. Stroke is a leading cause of long-term disability worldwide, and as populations age, the number of family caregivers will grow accordingly. Overburdened caregivers are at elevated risk of depression, physical illness and institutionalisation of the patient, creating a cascade in which the failure of one family member’s health accelerates the decline of another’s. By quantifying how family intimacy, family functioning and self-efficacy interlock with burden, the study gives health systems measurable targets. The authors note that reducing caregiver burden by improving self-efficacy through family support systems deserves the attention of healthcare providers, a recommendation this dataset substantiates with unusually large sample sizes and formal mediation testing.

As with any cross-sectional survey, the design captures a single moment in time and cannot establish causal direction; it remains possible that heavily burdened caregivers perceive their families as less intimate or their own efficacy as lower, rather than the reverse. The convenience sampling from a single Chinese region also limits generalisability, and cultural norms around filial caregiving may shape both burden levels and family dynamics in ways that differ across societies. Still, the internal consistency of the correlations, the alignment of the mediation results with family systems theory, and the sheer scale of the sample make the findings difficult to dismiss as statistical noise.

For the millions of families navigating the first year after an ischaemic stroke, the message is quietly hopeful. The burden of care is real and measurable, but it is not fixed. It bends when caregivers are given reasons to believe in their competence, and it bends further when families close the emotional distance that a stroke so often opens. The study’s authors and the nursing research community behind it are effectively issuing a prescription that no pharmacy fills: treat the family, not just the survivor, and the weight carried at the bedside becomes lighter for everyone.

Subject of Research: Family caregiver burden and its psychosocial determinants in first-ever ischaemic stroke patients

Article Title: Family caregiver burden in first-ever ischaemic stroke patients in relation to self-efficacy, family functioning and family intimacy: a cross-sectional survey

Article References: Guo, Y., Yang, Y., Zhou, F., Zhao, R., Wang, C., Yang, S., Wang, D., Li, X., Kuang, X., Chen, B., & Chen, Z. (2026). Family caregiver burden in first-ever ischaemic stroke patients in relation to self-efficacy, family functioning and family intimacy: a cross-sectional survey. BMC Nursing. https://doi.org/10.1186/s12912-026-05361-w

Image Credits: AI Generated

DOI: 10.1186/s12912-026-05361-w

Keywords: stroke, family caregiver burden, self-efficacy, family functioning, family intimacy, ischaemic stroke, caregiving, nursing research, cross-sectional survey, mediation analysis, Zarit Burden Interview, family systems